Imaging of the small bowel: Crohn’s disease in paediatric patients

Abstract

In more than 20% of all patients, the Crohn's disease presents before the age of 18 years. The diagnosis and management of Crohn's disease in children has changed dramatically over the last decade, mainly due to increased awareness, availability of newer diagnostic modalities such as magnetic resonance imaging (MRI) and newer, more powerful treatments such as biologics. Imaging of the small bowel is needed for diagnosis, management, follow-up and also evaluation of the disease in terms of location, extent, activity and complications. We review all the methods (barium examinations, ultrasonography, computed tomography, MR, and computed tomography-positron emission tomography) commonly used for imaging the small bowel in paediatric patients with Crohn's disease analyzing the advantages and disadvantages of each modality, with particular emphasis on MR imaging.

Abdominal ultrasonography of the pediatric gastrointestinal tract

“…Ultrasound demonstrates mural thickening with loss of wall stratification, hyperemia, and decreased peristalsis. Fluid collections, fistulae, lymph nodes, and mesenteric inflammation can also be seen [7,9,78] (Figure 4). Strictures…”

Bowel elastography – a pilot study for developing an elastographic scoring system to evaluate disease activity in pediatric Crohn’s disease.

“…The appearance of the peri-intestinal area, peritoneal fluid collections, and CD's complications (stenosis, abscesses, fistulas) were also assessed during the examination. Reaction of the mesenteric fat and enlargement of the lymph-nodes surrounding affected intestinal segment were considered signs of inflammation [3,6]. The absence of luminal expansion with suprajacent dilatation of the bowel was interpreted as a sign of stenosis.…”

“…The absence of luminal expansion with suprajacent dilatation of the bowel was interpreted as a sign of stenosis. Fistulas or abscesses were notified when linear hypoechoic trajectories, respectively delineated fluid collections, without Doppler signal inside were present in the thickened fat [3]. The complications were recorded as present or absent.…”

“…The most significant imaging findings include: irregular thickening of the intestinal wall, mainly the submucosa, mucosal ulcerations, loss of parietal stratification, or loss of haustration [3]. Periintestinal fat is also usually involved and there is enlargement of the mesenteric lymphnodes [3]. Several complications (fistula, abscess and stenosis) may also appear.…”

“…The accurate diagnosis should be based on a combination of history, physical and laboratory examination, esophagogastroduodenoscopy and ileocolonoscopy with histology, and imaging of the small bowel [2]. The most significant imaging findings include: irregular thickening of the intestinal wall, mainly the submucosa, mucosal ulcerations, loss of parietal stratification, or loss of haustration [3]. Periintestinal fat is also usually involved and there is enlargement of the mesenteric lymphnodes [3].…”